Information for Planning the Paramedic Workforce

Transcription

1 Information for Planning the Paramedic Workforce Country: Israel Partner Institute: The Myers-JDC-Brookdale Institute, Jerusalem Survey no: (9)2007 Author(s): Nirel, Nurit and Pinchas Halpern Health Policy Issues: HR Training/Capacities Current Process Stages Idea Pilot Policy Paper Legislation Implementation Evaluation Change 1. Abstract This pilot project examined the present and projected supply and demand for paramedics, the balance between supply and demand, and how this affects the planning of the paramedic workforce. Based on the data a forecast for the paramedic workforce was given until 2020 for several scenarios of demand. The data provide an evidence-based basis for long-term planning for training, recruitment, and employment of paramedics and therefore provide an incentive to improve these processes. 2. Purpose of health policy or idea Purpose: To examine the present and projected supply and demand for paramedics, the balance between supply and demand, and how this affects the planning of the paramedic workforce. Characteristics: A study to gather information about the current and projected supply for paramedics as well as the projected demand until Supply was assessed by the annual number of graduates of paramedic training programs, the duration of stay in the profession and the likelihood of staying in the profession, using data obtained by structured telephone interviews with a sample of graduates of paramedic courses; Demand was assessed by interviewing key figures in the emergency medical services (EMS). Based on the data a forecast for the paramedic workforce was given until 2020 for several scenarios of demand, which is a basis for planning training and recruitment policy. Expected outcome and incentives: The data provide an evidence-based basis for long-term planning for training, recruitment, and employment of paramedics and therefore provide an incentive to improve these processes. Groups affected Emergency Medicine Services employing paramedics - receive data for planning recruitment policy, Magen David Adom in Israel - the Israeli red cross which conducts most of the training courses for paramedics - received information for planning number of courses needed, Academic training programs for paramedics - receive information for planning the number of graduates needed in the system

2 3. Characteristics of this policy Degree of Innovation traditional innovative Degree of Controversy consensual highly controversial Structural or Systemic Impact marginal fundamental Public Visibility very low very high Transferability strongly system-dependent system-neutral Innovation - high since this is the first time that there is an attempt to assess the balance between supply and demand in this sector and the implications for training needs. Controversy - was not high since the method was comprehensive and included various demand scenarios that were in accordance with several stakeholders' interests. There was no attempt to define which is more likely to happen and therefore stakeholders did not oppose the method and findings. Structural impact - unknown at this early stage. Public visibility - very low, did not receive media attention. Transferability - rather high because the method could be applied to other health systems and other health professionals with minor adjustments. 4. Political and economic background Unrelated to polical or economic developments. 5. Purpose and process analysis Idea Pilot Policy Paper Legislation Implementation Evaluation Change Origins of health policy idea Too many paramedics? Paramedics are health professionals trained to provide emergency care and advanced life support (ALS) while transferring patients to the hospital. The paramedic profession in Israel is growing for a number of reasons: 1. The expansion of the EMS system that attempts to meet the needs of an aging and growing population; 2. The evidence that paramedics perform as well as physicians at the initial on-site intake of patients; 3. The training of paramedics for military purposes and the opening of academic tracks teaching the profession. The increasing number of paramedics raised the question whether their supply may exceed future demand. This - 2 -

3 question concerned the board of governors of the Magen David Adom (MDA) which is Israel's national emergency medical service provider by law. MDA is also the main training agency for paramedics. A prominent board member approached the Myers-JDC-Brookdale Institute and requested a study to address this question. This was the first time in Israel that an analysis of manpower supply and demand was conducted for this sector. Method of analysis The method of analysis was as follows: 1. Design: We examined supply by a telephone survey of graduates of paramedic training programs (excluding conscripted soldiers), whether or not they were working in the profession, between November 2005 and February 2006, using a structured questionnaire. To estimate the potential future workforce, we examined administrative data about training. To examine the various demand scenarios for paramedics we interviewed key persons in the EMS and nursing services. This method is known as a "normative" method for assessing demand for manpower. 2. Sampling method and size of sample: At the time of the study, there were 868 graduates of paramedic training programs, excluding conscripted soldiers. (Data source: lists of graduates). We selected a random sample of 578 paramedics (about 70% of the total), aiming to interview at least 50% of the study population. The response rate was 88%. Altogether 509 subjects (59% of the study population) were interiewed. 3. Study questionnaires: a) The telephone survey questionnaire included demographic variables, type and date of training, employment history as a paramedic (date of entering and leaving the profession) and information about the job (shifts, overtime, additional jobs and weekly hours). (b) The questionnaire that examines demand sought the respondent's estimate of the labor market for the professional workforce today and in another five years. 4. Forecasts: We estimated the forecasts for the supply and demand at three five-year periods beginning from The supply forecast was based on assumptions stemming from the study's findings on the rate of paramedics working in the civilian market, the rate of course graduates joining the labor market, the rate of those leaving the profession, and the rate of those persisting at the end of each period. We estimated the forecasts for demand according to the various scenarios. Each scenario took into account a natural growth of two ALS vehicles a year. Then we computed the balance between the supply and demand forecast for each scenario in terms of manpower positions. Study results The results of the study show that there are about 1000 certified paramedics in Israel. Of them, 64% are active in the civilian labor market. If the demand does not change beyond the natural annual increase of two advanced life support (ALS) ambulances (which are staffed by paramedics), there may be a surplus of 180 paramedics by Increased demand outside the EMS may temporarily absorb this surplus but it will reappear by 2015 or Conversely, upgrading all ambulances to ALS vehicles will result in a shortage of paramedics by 2010 (depending on the number of paramedics per vehicle) if the number of paramedics trained annually is not increased. Initiators of idea/main actors Providers: Magen David Adom (MDA), Israel's Red Cross ambulance service Scientific Community Others Approach of idea The approach of the idea is described as: new: Stakeholder positions A member of the board of the MDA - initiatied the study to gather information for the MDA in order to conduct an evidence-based planning process of manpower training and recruitment

4 Key persons Emergency Medical Services in Israel - Some hospitals wanted to assess the possibility of integrating paramedics in the hospital ER. Key nursing personnel - were interested in the process in order to secure their objection to expanding paramedic professional boundaries which may trespass into their professional domain. Emergency Medical Services program at Ben-Gurion University - was interested in the findings as a basis for planning future academic training programs for paramedics. The paramedic union - was interested and cooperative in the process because they saw this as a way to strengthen their professional status and organizational status in MDA (as the leading manpower source). Actors and positions Description of actors and their positions Providers A member of the board of the MDA very supportive strongly opposed Scientific Community Emergency Medical Service program very supportive strongly opposed at Ben-Gurion University Others Key persons in the Emergency very supportive strongly opposed Medical Services in Israel The paramedic union very supportive strongly opposed Influences in policy making and legislation Not relevant Legislative outcome Actors and influence Description of actors and their influence Providers A member of the board of the MDA very strong none Scientific Community Emergency Medical Service program very strong none at Ben-Gurion University Others Key persons in the Emergency very strong none Medical Services in Israel The paramedic union very strong none Positions and Influences at a glance Adoption and implementation The findings of the study will be presented to the MDA senior management. The study was presented to the Ben Gurion faculty at a special workshop organized on the topic of paramedic manpower. The study will also be published for the professional community. To date the findings were not yet implemented for several reasons: - 4 -

5 1. When the study was completed in the summer of 2006, the EMS were busy providing services in the North of Israel during the last Israel-Hizbulla conflict. Therefore the meeding with the senior MDA management was postponed. Furthermore, during the course of the study a new general director was appointed to MDA and he is less supportive of academic data sources and thus less enthusiastic to base planning of manpower in MDA on such studies. 2. The Ben Gurion program has received the findings but processes of re-assessment or change in academic institutions are lengthy in nature. The findings of the study would be of value to the MDA and the Ministry of Health when they decide on the ALS vehicles expansion rate. At that time the findings could be utilized to adapt the training rates of paramedics accordingly. (see results in section 5.1 above). Monitoring and evaluation No monitoring or evaluation of the implementation process planned. 6. Expected outcome At this time it is still early to assess whether the information will promote evidence-based workforce planning of the paramedic sector since the findings have just been published. Quality of Health Care Services marginal fundamental Level of Equity system less equitable system more equitable - 5 -

6 Cost Efficiency very low very high Quality of health care services - if quality of manpower planning is improved we assume that the ability to provide high quality services according to the needs of the population will increase. Cost efficiency - if manpower planning is more rational this will lead to more cost effective services. Equity - this policy is not expected to affect equity. 7. References Sources of Information Nurit Nirel, Rachel Goldwag, Zvi Feigenberg, David Abadi Pinchas Halpern (2007). Paramedics: the supply and demand for professional workforce. Myers-JDC-Brookdale Institute Jerusalem Research Report (Hebrew with English abstract). Hall TL. Demand. In: Hall TH, Mejia A, editors. Health Manpower Planning. Geneva: World Health Organization, Author/s and/or contributors to this survey Nirel, Nurit and Pinchas Halpern Suggested citation for this online article Nirel, Nurit and Pinchas Halpern. "Information for Planning the Paramedic Workforce". Health Policy Monitor, March Available at -